Effects of a Tailored Text Messaging Intervention Among Diverse Adults With Type 2 Diabetes: Evidence From the 15-Month REACH Randomized Controlled Trial

Abstract

OBJECTIVE Text messaging interventions have high potential for scalability and for reductions in health disparities. However, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. RESEARCH DESIGN AND METHODS Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized controlled trial and were assigned to receive Rapid Education/Encouragement and Communications for Health (REACH) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence and nontailored texts supporting other self-care behaviors. Outcomes included hemoglobin A1c (HbA1c), diabetes medication adherence, self-care, and self-efficacy. RESULTS Participants (N = 506) were approximately half racial/ethnic minorities, and half were underinsured, had annual household incomes <$35,000, and had a high school education or less; 11% were homeless. Average baseline HbA1c was 8.6% ± 1.8%; 70.0 ± 19.7 mmol/mol) with n = 219 having HbA1c ≥8.5% (69 mmol/mol). Half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (−0.31%; 95% CI −0.61%, −0.02%) was greater among those with baseline HbA1c ≥8.5% (−0.74%; 95% CI −1.26%, −0.23%), and there was no evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. CONCLUSIONS REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain the effects.

Telehealth Interventions to Improve Diabetes Management Among Black and Hispanic Patients: a Systematic Review and Meta-Analysis

“…The average duration of interventions, was 9 months, and the studies varied in the intensity of contact with participants from daily, weekly, to monthly—depending on the intervention modality. Telehealth interventions were primarily delivered by telephone calls [ 30 – 33 ], text messages [ 31 , 34 ], web-based portals [ 33 , 35 ], and virtual visits [ 36 ]. Patient-level only interventions primarily involved delivering diabetes self-management education (DSME) [ 30 , 31 , 34 – 36 ].…”

“…Telehealth interventions were primarily delivered by telephone calls [ 30 – 33 ], text messages [ 31 , 34 ], web-based portals [ 33 , 35 ], and virtual visits [ 36 ]. Patient-level only interventions primarily involved delivering diabetes self-management education (DSME) [ 30 , 31 , 34 – 36 ]. One patient-level intervention involved the use of remote monitoring devices assessing blood pressure control and blood glucose levels, pared with counseling and lifestyle recommendations specific to the patient [ 37 ].…”

Feasibility and Short‐Term Effects of a Multi‐Component Emergency Department Blood Pressure Intervention: A Pilot Randomized Trial

“…Although effects were small, individual incremental improvements in adherence, self‐care, or blood pressure have important implications on a population level. 64 , 65 An interactive text messaging intervention in the ED is a promising approach for identifying and engaging with otherwise difficult‐to‐reach or high‐risk patients.…”

Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2)

“…11 Recent publications of text messaging for people with diabetes, the Self-Management Support for Blood Glucose (SMS4BG) programme, the Cardiovascular Health and Text Messaging-Diabetes Mellitus (CHAT-DM) study and the Rapid Education/Encouragement and Communication for Health (REACH) programme have demonstrated small improvements in HbA1c of 0.3%-0.4% (3-4 mmol/mol). [41][42][43] There are studies showing the effectiveness of DHI interventions during pregnancy for weight management. For example, Guo et al's 44 RCT showed evidence of less weight gain among those using a mobile medical application compared with control (3.2±0.8 vs 4.8±0.7, p<0.001).…”